A three-dimensional finite element analysis to evaluate stress distribution tooth in tooth implant-supported prosthesis with variations in non-rigid connector design and location

The physiologically mobile natural tooth and rigidly fixed dental implant causes different distribution of stress when connected in prosthesis and nonrigid connector compensates this. Understanding of biomechanical behavior is necessary for an adequate choice and construction of this type of rehabilitation. However, there has been insufficient research focusing on different location and type of the nonrigid connector related with the prognosis of both implant and the tooth. Aim of the Study: The purpose of this finite element (FE) analysis was to evaluate the stress distribution around bone, implant, and tooth in tooth implant fixed prosthesis under static load with variations in design and location of nonrigid connectors under simulated functional loads. Materials and Method: Three, 3-dimensional FE models connecting tooth and implant were constructed with different location and type of nonrigid connector. Simulated occlusal load was applied on the restorations and stresses developed in the supporting structures were monitored. Results: The highest stresses were found around the implant in model with nonrigid connector placed between the tooth and implant and model with modified nonrigid connector. On the other hand, less stress was noted around the implant where nonrigid connector was placed between the implant and pontic. Conclusion: It is advisable to place the nonrigid connector between the implant and the pontic to protect the implant from torque effects in a tooth implant fixed prosthesis.

Tinea corporis due to Trichophyton violaceum: A report of two cases.

Dermatophytes are Fungi which infect keratinized tissues, that is, skin epidermis, hair and nails. Trichophyton violaceum is an anthropophilic, cosmopolitan dermatophyte. It primarily causes tinea capitis and less commonly tinea corporis and tinea unguium. We present a report of two cases of tinea corporis due to T. violaceum in children. Infections due to T. violaceum are important because of its transmissibility within families and community and its potential to spread and establish in new geographical areas.

Effect of propofol titration v/s bolus during induction of anesthesia on hemodynamics and bispectral index

Propofol when given as 2 mg/kg I.V bolus for induction of anesthesia is known to cause hypotension requiring vasopressors. The objective of our study was to compare Propofol 2 mg/kg single IV bolus [Precalculated group, PG] with the titration of Propofol [Titration group, TG] to clinical parameters as10 mg IV increments every 3 seconds on hemodynamic Parameters and Bispectral Index [BIS], during induction. The effect of titration on dose requirement for induction was also evaluated. Effects on Hemodynamic parameters [Heart rate [HR], systolic blood pressure [SBP], diastolic blood pressure [DBP] and mean arterial pressure [MAP]], and vasopressors use were recorded at baseline and every 2 minute intervals for 10 minutes. The percent difference in HR, SBP, DBP, and MAP from baseline at 2, 4, 6, 8 and 10 minutes were calculated, to determine the effect on hemodynamic parameters. BIS was recorded at baseline, after injection of Propofol, at intubation and at 10 minutes. Dose requirement of Propofol in TG was also recorded. At 2 and 4 minutes, SBP decreased in PG by 21% and 18% vs. 11% and 9% in TG [p = .00 and .02]; DBP decreased by 17% and 15% in PG vs. 5% and 4% in TG [p = .02 and .03]; MAP decreased by 19% and 17% in PG vs. 5% and 4% in TG [p = .00 and .01]. Vasopressors were required in 14/43 patients in PG vs. 5/41 in TG [p = .03]. Titration resulted in 30% reduction in dose. Titration of Propofol reduces hemodynamic changes, dose requirement and is able to achieve same level of BIS as in bolus

Adolescent vaccination.

Indian Academy of Pediatrics (IAP) has taken an important step towards adolescent vaccination. In the present article, the author has briefly described the needs for adolescent immunisation along with the IAP vaccination schedule for adolescents, in details.

HAART & the molecular biology of AIDS dementia complex.

The era of highly active antiretroviral therapy (HAART) has led to a considerable decline in the HIV disease progression rates and HIV-1-related opportunistic infections especially in developed countries. Unfortunately, antiretroviral treatment for almost 90 per cent of the HIV-infected population is not available because of cost concerns. Although a number of studies have shown uniform impact of HAART on disease progression, its effect on treating HIV infection of the brain and its manifestations, such as AIDS dementia complex (ADC), remains unclear. Along with the reasons why AIDS dementia complex continues to be a problem in the era of HAART, this review also discusses the changes in ADC patterns with HAART and its relevance in developing countries such as India. In addition, an overview of various biological, molecular and therapeutic aspects that may influence HIV dementia (HIV-D) is provided.

Obstacles to successful antiretroviral treatment of HIV-1 infection: problems & perspectives.

Mutations in human immunodeficiency virus type 1 (HIV-1) are a major impediment to successful highly active antiretroviral therapy (HAART) and the design of anti-HIV vaccines. Although HAART has made long-term suppression of HIV a reality, drug resistance, drug toxicity, drug penetration, adherence to therapy, low levels of continued viral replication in cellular reservoirs and augmentation of host immune responses are some of the most important challenges that remain to be sorted out. Continuing viral replication in the face of HAART leads to the accumulation of drug resistance mutations, increase in viral loads and eventual disease progression. Patients who fail therapy have minimal options for their clinical management. Therefore, a clear understanding of the pathogenesis of drug-resistant HIV-1, and all of the issues that influence the success of HAART is urgently needed. In the present article, we discuss various obstacles to HIV therapy, and provide perspectives relating to these issues that are critical in determining the success or failure of HAART.

H. influenzae type b (Hib) vaccine--controversies.

Hib vaccine is the 8th vaccine knocking at the door to be included in the EPI the world over. However there are some controversies that need to be addressed, especially when it comes to use of this vaccine in India. It is difficult to culture Hib unless one uses sheep blood enriched media for culture. There is a lack of good community based data on Hib burden in India. This makes many feel that Hib is rare in India. However this is not true. There are many studies that have looked at this closely. Hib is a common cause of meningitis and pneumonitis in children less than 5 years old in India. There is wide spread problem of multi-drug resistance by Hib in India. Mortality of meningitis is as high as 100% if third generation cephalosporins are not used in time. Of the survivors of meningitis, 60% develop long-term sequelae. Hib vaccine is very effective and can lead to 99% reduction with mass vaccination in just 2-3 years. It is also a very safe vaccine. Of the conjugated vaccines available in India all are equally effective and safe and there is nothing to choose one over the other. There is a need to give a booster dose at 15-18 months of age. Even UK, which never gave the booster dose, is seriously thinking of changing their practice and give a booster dose. Lastly the combination vaccines of Hib with IPV, DPwT/DPaT, and Hepatitis B are safe and effective and should be encouraged to improve the compliance. The use of Hib vaccine is recommended in India, for those who can afford the vaccine.

The current practice of percutaneous transluminal coronary angioplasty (PTCA) and stent deployment and their long-term results in unstable and stable angina.

Percutaneous transluminal coronary angioplasty with stent implantation is a universally accepted therapeutic option for patients with coronary artery disease. Since introduction in 1977, angioplasty techniques have been greatly improved; the availability of better hardware, greater operator experience, better patient selection and the judicious use of adjunctive therapy like heparin, clopidogrel, platelet receptor antagonists like abciximab and the use of atherectomy/rotablator in given situations has greatly improved procedural outcome today. Angioplasty alleviates symptoms in patients with stable angina and also in unstable angina especially in high risk patients like those with pulmonary oedema, cardiogenic shock or patients refractory to conventional modes of therapy, though cost may be a prohibiting factor. The outcome of angioplasty in diabetic patients is universally poor and bypass surgery is always a better option. Women with coronary artery disease tend to have complex lesions with a sub-optimal outcome and a higher incidence of restenosis. Use of abciximab is always beneficial in both men and women.